Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of ...resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden.
We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017.
Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval UI 140.3-161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0-1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9-82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1-71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries.
Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.
Neurotoxicity is a burdensome side effect of platinum‐based chemotherapy that prevents administration of the full efficacious dosage and often leads to treatment withdrawal. Peripheral sensory ...neurotoxicity varies from paresthesia in fingers to ataxic gait, which might be transient or irreversible. Because the number of patients being treated with these neurotoxic agents is still increasing, the need for understanding the pathogenesis of this dramatic side effect is critical. Platinum derivatives, such as cisplatin and carboplatin, harm mainly peripheral nerves and dorsal root ganglia neurons, possibly because of progressive DNA‐adduct accumulation and inhibition of DNA repair pathways (e.g., extracellular signal‐regulated kinase 1/2, c‐Jun N‐terminal kinase/stress‐activated protein kinase, and p38 mitogen‐activated protein kinass), which finally mediate apoptosis. Oxaliplatin, with a completely different pharmacokinetic profile, may also alter calcium‐sensitive voltage‐gated sodium channel kinetics through a calcium ion immobilization by oxalate residue as a calcium chelator and cause acute neurotoxicity. Polymorphisms in several genes, such as voltage‐gated sodium channel genes or genes affecting the activity of pivotal metal transporters (e.g., organic cation transporters, organic cation/carnitine transporters, and some metal transporters, such as the copper transporters, and multidrug resistance‐associated proteins), can also influence drug neurotoxicity and treatment response. However, most pharmacogenetics studies need to be elucidated by robust evidence. There are supportive reports about the effectiveness of several neuroprotective agents (e.g., vitamin E, glutathione, amifostine, xaliproden, and venlafaxine), but dose adjustment and/or drug withdrawal seem to be the most frequently used methods in the management of platinum‐induced peripheral neurotoxicity. To develop alternative options in the treatment of platinum‐induced neuropathy, studies on in vitro models and appropriate trials planning should be integrated into the future design of neuroprotective strategies to find the best patient‐oriented solution.
This review summarizes preclinical and clinical evidence of pathogenesis and pathophysiology of platinum‐induced peripheral neurotoxicity, as well as available evidence of neuroprotective and therapeutic strategies. These data may help to develop alternative options in the treatment of platinum‐induced neuropathy, studies on in vitro models, and appropriate trials planning to find the best patient‐oriented solution.
The relative contributions of vascular and degenerative pathology to dementia are unknown. We aim to quantify the proportion of dementia explained by potentially preventable vascular lesions.
We ...systematically searched for population-based cohorts before February 2017 reporting clinicopathological data for individuals with and without dementia. We calculated the summary proportion and absolute risk of dementia comparing subjects with and without the pathology.
We identified 10 studies comprising 2856 subjects. Vascular-type pathology and mixed pathology are respectively two and three times more likely in demented patients. The summary proportion of dementia is 77%–86% in subjects with mixed degenerative and vascular pathology and 45% in subjects with pure Alzheimer-type pathology.
Patients with mixed pathologies have nearly twice the incremental risk of dementia compared with patients with only Alzheimer-type lesions. Consequently, many cases of dementia could be prevented or delayed by targeting the vascular component.
•Vascular lesions were the most frequent types of brain lesions (44%) in the elderly.•Vascular-type pathology is two-times more likely in demented vs. nondemented subjects.•Mixed pathology doubles the risk of dementia compared with only degenerative lesions.•Mixed pathology is three-times more likely in demented vs. nondemented subjects.•Many cases of dementia could be prevented or delayed by targeting vascular component.
Reducing health inequalities among older adults is crucial to ensuring healthy aging is within reach for all. The current study provides a timely update on demographic- and geographic-related ...inequalities in healthy aging among older adults residing in Canadian communities. Data was extracted from the Canadian Health Survey on Seniors 2019-2020 for ~6 million adults aged 65 years and older residing in 10 provinces of Canada. Healthy aging was defined by two indices: 1 health-related quality of life and 2 functional health. Poisson regression models and spatial mapping were used to demonstrate inequalities among age, race, and sex categories, and health regions. Approximately 90.3% of individuals reported less than perfect quality of life and 18.8% reported less than perfect functional health. The prevalence of less than perfect quality of life was higher for females PR 1.14, 95% CI;1.02-1.29 and for older adults aged greater than or equal to80 years as compared to males and older adults aged less than or equal to79 years PR 1.66, 95% CI;1.49-1.85. Similarly, the prevalence of less than perfect functional health was higher for females PR 1.58, 95% CI;1.32-1.89 and for older adults aged greater than or equal to80 years PR 2.71, 95% CI;2.59-2.84. Spatial mapping showed that regions of lower quality of life were concentrated in the Prairies and Western Ontario, whereas regions of higher quality of life were concentrated in Quebec. Amongst older individuals residing in Canadian communities, less than perfect quality of life and functional health is unequally distributed among females, older adults aged greater than or equal to80 years, and those residing in the Prairie regions specifically. Newer policy should focus on interventions targeted at these subpopulations to ensure that healthy aging in within reach for all Canadians.
Wilson’s disease (WD) is a hereditary disorder of copper metabolism, producing abnormally high levels of non-ceruloplasmin-bound copper, the determinant of the pathogenic process causing brain and ...hepatic damage and dysfunction. Although the disease is invariably fatal without medication, it is treatable and many of its adverse effects are reversible. Diagnosis is difficult due to the large range and severity of symptoms. A high index of suspicion is required as patients may have only a few of the many possible biomarkers. The genetic prevalence of ATP7B variants indicates higher rates in the population than are currently diagnosed. Treatments have evolved from chelators that reduce stored copper to zinc, which reduces the toxic levels of circulating non-ceruloplasmin-bound copper. Zinc induces intestinal metallothionein, which blocks copper absorption and increases excretion in the stools, resulting in an improvement in symptoms. Two meta-analyses and several large retrospective studies indicate that zinc is equally effective as chelators for the treatment of WD, with the advantages of a very low level of toxicity and only the minor side effect of gastric disturbance. Zinc is recommended as a first-line treatment for neurological presentations and is gaining acceptance for hepatic presentations. It is universally recommended for lifelong maintenance therapy and for presymptomatic WD.
•Globally, there was a significant correlation between healthy life expectancy (HALE), non-communicable disease DALYs and mortality, with COVID-19 caseload and deaths.•There was a positive ...independent association between HALE and COVID-19 cases.•The number of tourists was also associated with COVID-19 mortality.•Our integrated model of global data is valuable for health policymakers, allowing for the implementation of optimal preventative measures at national and global scales.
The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases.
We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis.
High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model.
Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.
We aimed to summarize the available evidence on cerebral blood flow (CBF) changes in normal aging and common cognitive disorders. We searched PubMed for studies on CBF changes in normal aging and ...cognitive disorders up to 1 January 2019. We summarized the milestones in the history of CBF assessment and reviewed the current evidence on the association between CBF and cognitive changes in normal aging, vascular cognitive impairment (VCI) and Alzheimer’s disease (AD). There is promising evidence regarding the utility of CBF studies in cognition research. Age-related CBF changes could be related to a progressive neuronal loss or diminished activity and synaptic density of neurons in the brain. While a similar cause or outcome theory applies to VCI and AD, it is possible that CBF reduction might precede cognitive decline. Despite the diversity of CBF research findings, its measurement could help early detection of cognitive disorders and also understanding their underlying etiology.
Background
We assessed secular trends in the burden of ischaemic heart disease (IHD), stroke, and dementia in the Organization for Economic Co-operation and Development (OECD) countries.
Methods
...Using the Global Burden of Disease (GBD) Study 2017, we compared sex-specific and age-standardized rates of disability-adjusted life years (DALY); mortality, incidence, and prevalence of IHD and stroke; and dementia per 100,000 people, in the world, OECD countries, and Canada.
Results
From 1990 to 2017, the crude incidence number of IHD, stroke, and dementia increased 52%, 76%, and 113%, respectively. Likewise, the prevalence of IHD (75%), stroke (95%), and dementia (119%) increased worldwide. In addition during the study period, the crude global number of deaths of IHD increased 52%, stroke by 41%, and dementia by 146% (9, 6, and 3 million deaths in 2017, respectively). Despite an increase in the crude number of these diseases, the global age-standardized incidence rate of IHD, stroke, and dementia decreased by −27%, − 11%, and − 5%, respectively. Moreover, there was a decline in their age-standardized DALY rates (− 1.17%, − 1.32%, and − 0.23% per year, respectively) and death rates (− 1.29%, − 1.46%, and − 0.17% per year, respectively), with sharper downward trends in Canada and OECD countries. Almost all trends flattened during the last decade.
Conclusions
From 1990 to 2017, the age-standardized burden of IHD, stroke, and dementia decreased, more prominently in OECD countries than the world. However, their rising crude numbers mainly due to population growth and ageing require urgent identification of reversible risk and protective factors.
Introduction
Stroke and dementia share a number of modifiable risk factors and are the leading cause of neurological disability and death worldwide.
Methods
We report the 2019 estimations for global ...disability‐adjusted life years (DALYs) and death numbers and rates related to stroke and dementia, as well as their risk attributed DALYs and deaths and their changes between 2010 and 2019.
Results
Stroke accounted for 69.8%, dementia for 17.3%, and combined contributed to 87.2% (8.2 million) of neurological deaths and 61.7% (168.5 million) of neurological DALYs in 2019. For stroke, 86.4% of DALYs and for dementias 32.8% of DALYs are attributable to risk factors. Globally, hypertension (54.8%) and unhealthy diet (30.0%) pose the greatest risk for stroke DALYs, and smoking (15.1%) and obesity (12.5%) for dementia DALYs.
Discussion
Worldwide, stroke and dementia cases are increasing in number, but their age‐standardized rates are falling. Finding out why offers the possibility of their joint delay, mitigation, or prevention.
Background
An ample literature documents the growing prevalence of dementia and associated costs. Less attention has been paid to decreased dementia incidence in some countries.
Methods
We analyzed ...trends in age‐standardized dementia, stroke, and ischemic heart disease (the triple threat) incidence rates and population attributable fraction of death and disability attributable to 12 risk factors in 204 countries and territories and 51 regions using Global Burden of Disease 2019 data.
Results
During 1990 to 2019, dementia incidence declined in 71 countries; 18 showed statistically significant declines, ranging from –12.1% (95% uncertainty intervals –16.9 to –6.8) to –2.4% (–4.6 to –0.5). During 2010 to 2019, 16 countries showed non‐significant declines. Globally, the burden of the triple threat attributable to air pollution, dietary risks, non‐optimal temperature, lead exposure, and tobacco use decreased from 1990 to 2019.
Conclusion
The declining incidence of dementia in some countries, despite growing prevalence, is encouraging and urges further investigation.
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